Patient complaints to SUSALUD: what to do when a clinic, your insurer or EsSalud fails you

The underlying mistake: assuming you complain straight to SUSALUD

When a clinic treats you badly, your insurer drags its feet authorizing something, or EsSalud denies you a benefit, the natural instinct is to go to the biggest, most powerful agency: SUSALUD, Peru’s national health superintendency. But that’s not how the system works. Decreto Supremo N.° 002-2019-SA organizes the protection of the right to health into two separate tracks, and most cases have to go through the first one before the second.

Track one: the reclamo, filed directly with whoever failed you

Every user has the right to file a reclamo, but not with SUSALUD — with the IAFAS (your insurer: EsSalud, an EPS or another IAFAS), the IPRESS (the clinic, health post or hospital that treated you) or the UGIPRESS, whichever applies. Article 14 is clear:

“Todo usuario o tercero legitimado tiene derecho a presentar su reclamo ante la IAFAS, IPRESS y UGIPRESS, por la insatisfacción con los servicios, prestaciones o coberturas relacionadas con su atención en salud. Los reclamos son presentados mediante el llenado del Libro de Reclamaciones en Salud físico o virtual de la IAFAS, IPRESS o UGIPRESS.”

One detail almost nobody knows: they cannot refuse your reclamo for lack of proof. Article 14.7 says it plainly: “La recepción del reclamo no puede rechazarse por falta de pruebas que lo sustenten.” You don’t need to show up with an independent medical report or an expert opinion — the reclamo has to be admitted regardless, and investigating it is the entity’s job.

Once filed, they have 30 business days to resolve it (article 11), plus 5 more business days to notify you of the outcome in writing (article 24.1). In practice, expect a formal answer within roughly five business weeks.

Watch out if your insurer is an insurance company. The same regulation makes an exception in Article 4.2:

“4.2. En el caso de la IAFAS señaladas en los numerales 6) y 7) del artículo 7 del Texto Único Ordenado de la Ley N° 29344, Ley Marco de Aseguramiento Universal en Salud, aprobado por Decreto Supremo N° 020-2014-SA, los procedimientos para la atención de consultas y reclamos son determinados por la Superintendencia de Banca y Seguros y Administradoras de Fondos de Pensiones.”

(For the IAFAS listed in items 6 and 7 of Article 7 of the consolidated Ley 29344, complaint procedures are set by the SBS.)

Items 6 and 7 of that Article 7 are insurance companies selling health cover and AFOCATs; EPS (item 5) stay under SUSALUD’s rules. For insurance companies and AFOCATs, the SBS complaints regulation (Res. SBS 04036-2022) says: “Los reclamos deben ser resueltos por las empresas en un plazo no mayor a quince (15) días hábiles” (complaints must be resolved within 15 business days). What to do if a private insurer denies coverage is covered in private health insurance denied coverage in Peru: pre-existing conditions and where to complain.

Track two: the denuncia, filed directly with SUSALUD

The denuncia only comes into play in specific situations, under article 27: when there’s a direct violation of the right to health that warrants SUSALUD’s own intervention, when you’re unsatisfied with your reclamo’s outcome, when you’re refused care, or when there was an irregularity in how your reclamo was processed. It’s not an alternative to the reclamo — it’s usually what comes after.

Two things make it more accessible than people assume: article 28.4 says a lawyer’s signature is never required, and article 28.5 says the process is free. You don’t need to pay anyone for SUSALUD to look into it.

Once the denuncia is open, SUSALUD has 25 business days to issue its intervention report (article 30.6). And there’s one deadline that works in your favor: the entity you denounced (your IAFAS, IPRESS or UGIPRESS) has only 10 business days, non-extendable, to send SUSALUD whatever information it requests; missing that can itself trigger a sanctioning procedure against them (article 34.2).

What a denuncia does NOT get you: money

Here’s the point that surprises people most, and it’s worth knowing before investing time in the wrong process. Article 30.7 says it explicitly:

“En ningún caso el resultado de la denuncia da lugar a declaración de indemnización, en la vía administrativa, a favor del usuario por los daños o perjuicios que hayan podido causar la IAFAS, IPRESS o UGIPRESS según corresponda, quedando a salvo su derecho para acudir al CECONAR y hacer uso de los medios alternativos de solución de controversias, de acuerdo a la normativa vigente o la vía judicial.”

SUSALUD can order the entity to correct what it did wrong, and even sanction it. But it cannot order them to pay you for what happened. If what you’re after is financial compensation, the path is different: CECONAR, the conciliation, mediation and arbitration center that SUSALUD itself promotes (article 13.1), or the ordinary courts.

Your reclamo stays on file for years

The IAFAS, IPRESS or UGIPRESS must keep the complete file of your reclamo for four years from its conclusion (article 26.2). That means if you need to revisit the case later — to support a denuncia, a CECONAR case, or a court claim — that documentary record should still exist.

How to protect yourself in practice

• Always file the reclamo first, even when you’re sure you’re right. It’s the mandatory step before a denuncia in most cases.
• Keep a copy or receipt of your reclamo (physical or virtual) with its filing date — you’ll need it to count the deadlines and to support a denuncia if you’re unhappy with the outcome.
• If the 30-business-day deadline passes with no answer, that alone can be the irregularity that lets you file a denuncia directly with SUSALUD.
• If what you need is financial compensation, don’t expect that from the denuncia — route that part of your case to CECONAR or the courts from the start.